US slips in maternal and child health ranking

The United States has slipped two places in a major international index of maternal and child health, placing 33rd among 179 countries. That’s mostly because other countries are improving faster than the U.S. is.

“Other countries are passing us by,” Carolyn Miles, CEO of Save the Children, which put out the report, told reporters at the United Nations Thursday. She expressed hope that the Affordable Care Act would improve maternal health outcomes in this country.

The State of the World Mother’s Report ranks countries by crunching maternal health (a mother’s lifetime risk of dying as a result of pregnancy or childbirth), children’s well-being (a child’s risk of dying before his or her fifth birthday), overall per capita economic status, and the expected time children will spend in school – an average of 18 years in the top 10, eight in the bottom 10. They also included the representation of women in office.

Predictably, the top five includes every single Scandinavian country, with Norway first among them. Then come the Netherlands, Spain, Germany, Australia and Belgium. One must scroll down quite a bit to get to the US. The bottom 10 are all in Africa, except for Haiti, which tied with Sierra Leone at 170. (Haiti is a new entrant, since there wasn’t good data from it before.)

The report, timed for Mother’s Day, also includes extensive recommendations for solutions, from investing in nutrition and good sanitation in less developed countries to better education about the resources that exist in richer countries.

Globally, there have been massive improvements in infant mortality over the past 20 years, cutting the overall rate in half, from 90 deaths per 1,000 live births to 46 deaths per 1,000 births in 2013.

This year, in recognition of the fact that the world’s poor are increasingly clustered in cities, the report adds a new analysis: The disparities between rich and poor in a given city. That allowed researchers to see how much overall improvements in, say, Delhi were actually trickling down to the most disadvantaged families. That’s how they learned that despite broad gains in Kenya, Rwanda and Malawi’s cities, the gap between rich and poor children’s survival had actually doubled.

In fact, when the researchers looked at capital cities in richer countries, the city that had one of the widest gaps between rich and poor children’s survival rate was Washington, D.C. There, a baby born in Ward 8 is about 10 times more likely to die before his/her first birthday than a baby born in a richer neighborhood.